Neighborhood Health Plan of Rhode Island

Welcome to the Neighborhood Health Plan of Rhode Island page.  The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent (formerly National Imaging Associates, Inc.) is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.

If you have any questions about our programs, please contact your dedicated Evolent Provider Relations Manager, Mara Grimm.

Effective October 10, 2024, post-service prior authorizations, also known as retro authorizations, will no longer be accepted for the INTEGRITY (MMP) line of business. All providers seeking authorization must obtain approval prior to services being rendered. This aligns with standards set by the Centers for Medicare and Medicaid Services (CMS). Please note this update applies to the MMP line of business only.

If a prior authorization request is submitted after the care is provided, Neighborhood will issue a dismissal notice advising the provider to submit a claim for processing. Should the claim deny, the provider will need to follow the provider administrative appeal process. 

MEDICARE plans: Effective 8/5/2024, peer-to-peer discussions must be performed before a final determination has been made on the request. Medicare re-opens are only allowed if the request complies with the CMS definition of a re-open. Providers will continue to have the option to submit an appeal utilizing the health plan’s process. 

Conservative Treatment Forms  

For access to our conservative treatment forms, click here.